What is AERD/Samter’s Triad?
Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.
What are the symptoms?
Patients with AERD/Samter’s Triad usually have asthma, nasal congestion, and nasal polyps, and often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter’s Triad is that patients develop reactions triggered by aspirin or other NSAIDs.
These reactions can include:
- Increased nasal congestion or stuffiness
- Eye watering or redness
- Cough, wheezing, or chest tightness
- Frontal headache or sensation of sinus pain
- Flushing and/or a rash
- Nausea and/or abdominal cramping
- General feeling of malaise, sometimes accompanied by dizziness
If you not do have asthma, nasal congestion and/or nasal polyps but experience reactions to aspirin or NSAIDs, click here and here to learn about the Brigham and Women’s Aspirin and NSAID Allergy Clinic. The Aspirin/NSAID Allergy new patient packet can be found here.
The cause of severe nasal polyposis in AERD is unknown. To understand the role of antibody-secreting cells in AERD, Buchheit et al. studied these cells in nasal polyps. They noted that polyp IgE and IgG4 levels were elevated in subjects with AERD compared with aspirin-tolerant subjects with nasal polyposis – those with higher tissue IgE levels had more rapid nasal polyp recurrence. Plasma cells in the nasal polyps of AERD also had a higher surface expression of IL-5Rα compared to aspirin-tolerant subjects, and IL-5 stimulation of nasal polyp plasma cells from subjects with AERD induced changes in a distinct set of genes. These findings suggest a role for IL-5Rα+ antibody-secreting cells in producing antibodies within the sinus tissue and perhaps contributing to the severe nasal polyposis in patients with AERD.
Bronchiectasis is a chronic disease in which the lungs’ bronchi (airway walls) are damaged and widened. In addition to scarred bronchi, symptoms include repeated sinus infections, coughing up mucus, and difficulty breathing. There are several risk factors for bronchiectasis including chronic rhinosinusitis, both with and without polyps, and asthma. Considering that those with AERD have both conditions, the authors of this paper looked at over 700 patients with AERD and found that of the 149 who had a prior lung CT scan, 57 were found to have bronchiectasis noted on the CT scan. AERD patients with bronchiectasis tended to be older and to have had AERD for a longer duration of time. They also had higher rates of pneumonia, aspiration, and mycobacterial infection. Given the evidence presented in the paper, patients with aspirin-exacerbated respiratory disease and poorly controlled respiratory symptoms should be evaluated for comorbid bronchiectasis.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complicated disease with no definitive cure. As with other complex diseases, experts largely agree that a multidisciplinary approach is the most beneficial for patients. We recommend that patients with CRSwNP seek care from both an allergist/immunologist and otolaryngologist. The allergist/immunologist can diagnose and manage the disease and other co-morbid conditions while the otolaryngologist can perform nasal endoscopies, biopsies and surgery if needed. In the case of aspirin-exacerbated respiratory disease (AERD), aspirin desensitization is often recommended after surgery to increase success and prevent the polyps from recurring. Collaboration between allergists/immunologists and otolaryngologists gives a well-rounded, patient-centered approach to effectively manage CRSwNP. More information about the benefits of a multidisciplinary approach can be found here.